| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $26 | $26 | $26 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $62 | $62 | $62 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $100 | $100 | $100 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $19 | $19 | $19 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $84 | $84 | $84 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $30 | $30 | $30 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $16 | $16 | $16 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $76 | $76 | $76 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $13 | $13 | $13 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $98 | $98 | $98 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $24 | $24 | $24 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $11 | $11 | $11 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $36 | $36 | $36 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $19 | $19 | $19 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $28 | $28 | $28 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $8 | $8 | $8 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $1 | $1 | $1 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $30 | $30 | $30 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $5 | $5 | $5 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $30 | $30 | $30 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $92 | $92 | $92 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $10 | $10 | $10 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $8 | $8 | $8 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $3 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $78 | $78 | $78 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $8 | $8 | $8 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $69 | $69 | $69 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $179 | $179 | $179 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $84 | $84 | $84 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $927 | $927 | $927 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $851 | $851 | $851 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $31 | $31 | $31 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $3,359 | $3,359 | $3,359 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $32 | $32 | $32 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $152 | $152 | $152 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $32 | $32 | $32 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $26 | $26 | $26 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $213 | $213 | $213 |
| Septoplasty CPT 30520 • ENT | $523 | $523 | $523 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $108 | $108 | $108 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $30 | $30 | $30 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $119 | $119 | $119 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $30 | $30 | $30 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $48 | $48 | $48 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $178 | $178 | $178 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $262 | $262 | $262 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $56 | $56 | $56 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $28 | $28 | $28 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $285 | $285 | $285 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $148 | $148 | $148 |